Assessment and health-related quality of life evaluation of critical care patients, 1 year after intensive care discharge

Introduction

Outcome from intensive care has focused on reducing morbidity–mortality during hospitalization, but nowadays it incorporates the assessment of long-term survival and quality of life in survivors [1]. Our aim was to assess morbidity (physical and psychological) and health-related quality of life (HRQL) in patients discharged from the ICU.

Methods

A longitudinal prospective and descriptive study of patients discharged from the ICU. They were interviewed at 3, 6 and 12 months at an outpatient clinic. Assessment of physical morbidity was performed each time, as well as Folstein's Mini Mental State Examination (MMSE) for cognitive evaluation, Barthel index and Short-Form 36 version 2 (SF-36) to evaluate functional activity and HRQL.

Results

We included 132 patients (13 with less than 1 year of follow-up); mean ± SD age 37 ± 17 years. Clinical data: Simplified Acute Physiology Score II 30 ± 14; stay in the ICU 21 ± 16 days, in hospital 39 ± 28 days. Causes of admission: neurologic 59, septic 27, trauma 18. Required mechanical ventilation, 107 (81%) patients. In the first interview 130 patients were at home. A year after discharge, 90 patients survived, three died and 26 were lost to follow up. At first control 22 patients had dysphonia, six tracheal stenosis and eight swallowing-related problems; pressure ulcers, 16 patients. Four were aphasics, 50 with muscle weakness, paralysis or numbness. In 46 patients, psychological disorders were diagnosed; 32 anxiety/depression, 14 sleep disorders. Sixty-five patients had a previous job, only 14 (21%) returned to work at 3 months, rising to 22 (34%) at 1 year. Only 13 patients had a MMSE with a cutoff point <27. The SF-36 showed better results in all areas in patients with ≤ 10 days stay, being significant for physical function. Higher physical dependence was associated with worse perception of health and quality of life. Comparing SF-36 dimensions at 3, 6 and 12 months, better results were obtained in most of them. Longitudinal analysis of the Barthel index showed at 1 year that most patients were low dependent or independent.

Conclusion

Follow-up of critically ill patients after discharge allows us to identify common physical and psychological problems. The results showed worse HRQL perception in patients with longer stays. A year after discharge, most patients showed a great improvement in HRQL perception and lower physical dependency levels.